Digital Divide Among Beneficiaries and Medicare Diabetes Prevention Program.

INTRODUCTION: Successful delivery of the virtual Medicare Diabetes Prevention Program (MDPP) is influenced by a beneficiary's access to a computer and use of the Internet. METHODS: Using the 2020 nationally representative Medicare Current Beneficiary Survey Public Use File, a three-level categorical dependent variable was created: (1) has a computer AND uses Internet, (2) has a computer OR uses Internet, and (3) has no access to either (reference group). A survey-weighted multinomial logit model was performed in 2023 to examine associations between socio-demographics, comorbidities, and computer access and Internet use. RESULTS: Of study beneficiaries aged ≥65 years with BMI≥25 kg/m2 and no history of diabetes (n=3,875), 70.8% had a computer AND used Internet; 14.3% had a computer OR used Internet; and 14.9% had no computer AND did not use Internet. Hispanics and non-Hispanic Blacks (OR=0.28, 95% CI [0.17-0.43]) were less likely than non-Hispanic Whites to have a computer AND use Internet. Beneficiaries with less education (

Food insecurity and glycemic goals among Medicare beneficiaries with type 2 diabetes.

OBJECTIVE: To examine the association between food insecurity and achieving glycemic goals among Medicare beneficiaries with type 2 diabetes. METHODS: This study analyzed the nationally representative 2019 Medicare Current Beneficiary Survey of 1340 beneficiaries aged ≥65 years with type 2 diabetes. The binary dependent variable was whether beneficiaries' blood glucose was at target (A1C ≤ 7.5% or average fasting blood glucose of ≤140 mg/dL, all/most of the time). Food insecurity, a binary variable, was adapted based on the USDA's food security questions. A survey-weighted multivariable logistic model, adjusted for sociodemographics and comorbidities, was conducted to estimate predictive margins for comparing prevalence of having above-target blood glucose levels across groups. RESULTS: Of study beneficiaries, 20.9% reported not achieving glycemic targets. The predictive marginal prevalence of having higher than target blood glucose levels was significantly greater in females over males (23.8% [95% confidence interval [CI], 20.1-27.4] vs 17.6% [14.3-20.9]); those with less than high school education over those with college education (31.0% [23.6-38.3] vs 18.6% [14.8-22.3]); and those reporting food insecurity over their counterparts (33.4% [24.5-42.3] vs 19.1% [16.6-21.7]). CONCLUSIONS: Sociodemographic disparities related to achieving blood glucose goals were observed. Screening for food insecurity and related interventions should be considered for at-risk beneficiaries with diabetes.

Food Insecurity Among Medicare Beneficiaries With Type 2 Diabetes: Implications for Diabetes Care and Education Specialists.

PURPOSE: The purpose of the study was to examine factors associated with food insecurity among Medicare beneficiaries with type 2 diabetes. METHODS: The 2019 Medicare Current Beneficiary Survey Public Use File of beneficiaries ≥65 years old with type 2 diabetes (n = 1343) was analyzed. A binary variable was created to represent food insecurity (1 = food insecurity, 0 = without food insecurity) with ≥2 affirmative responses adapting an established algorithm of the United States Department of Agriculture food insecurity questionnaire. A survey-weighted logistic model was performed to examine factors (ie, sociodemographic characteristics, health status, and insurance coverage) associated with food insecurity. RESULTS: Approximately 11.6% of study Medicare beneficiaries with type 2 diabetes reported food insecurity. Non-Hispanic Black beneficiaries were more likely to report food insecurity than non-Hispanic White beneficiaries. Beneficiaries with incomes < $25 000 were more likely to report food insecurity than those with higher incomes. Beneficiaries enrolled in Medicare Advantage programs (vs traditional Medicare), having Medicare-Medicaid dual eligibility (vs nondual), and living with instrumental activities of daily living or activities of daily living limitations (vs without) were also more likely to report food insecurity than their respective counterparts. CONCLUSIONS: Sociodemographic disparities in food insecurity were observed among Medicare beneficiaries with type 2 diabetes. Implementation of screening protocols, interventions related to social determinants of health, and the diabetes care continuum may mitigate the prevalence of food insecurity in this demographic.